Effective April 14, 2003
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
“Protected Health Information” is information that identifies you and relates to your past, present or future physical or mental health or condition; the provision of health care to you; or the past, present, or future payment for health care furnished to you. In this notice, we call Protected Health Information "health information". If you have any questions about this notice, please contact the Ebenezer Privacy Office at 612-874-3474.
OUR PLEDGE REGARDING HEALTH INFORMATION:
We understand that health information about you is personal. We are committed to protecting the privacy of your health information by complying with all applicable federal and state privacy and confidentiality requirements. Accordingly, we have developed policies, enhanced the controls over our computers and other systems, which access and store health data, and educated our employees about protecting your health information. We are required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices with respect to health information. .
This health care facility is part of Ebenezer. Ebenezer provides a variety of health care services to the community. In doing so, the various parts of the system obtain health information about and from their residents. As we obtain this information, we create a record of the care and services you receive at Ebenezer. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways in which we may use and disclose health information about you. It also describes the rights you have with respect to accessing your information, certain obligations we have regarding the use and disclosure of your health information and how we ensure that it is kept private.-
Ebenezer provides a wide variety of health care services through various separate, but related legal entities. At the end of this notice is a list of certain Ebenezer facilities. For privacy purposes, all of these entities are considered one covered entity and all will follow the terms of this Notice. In order to help the entire system provide quality health care, we share health information between Ebenezer entities if appropriate. We share information among the different parts of the system to help ensure better and more convenient care for the resident. All of our employees, volunteers, and agents will comply with the terms of this notice.
This notice applies to all of the records of your care generated by us, whether made by our staff or your personal physician or other health care provider. Your physician or other non-physician health care provider may not be an Ebenezer employee. Instead, when providing care at an Ebenezer facility, they may be a member of the medical staff or allied health staff or an employee of a company we have contracted with to help us provide services.
When these providers are treating you at an Ebenezer facility, they will follow the terms of this notice. Your personal physician or other health care provider may have different policies or notices regarding their use and disclosure of your health information created in their office or clinic.
PROTECTING THE SECURITY OF YOUR HEALTH INFORMATION
Ebenezer strives to protect the privacy and security of your health information while you are treated and after your treatment has ended. Ebenezer uses electronic record systems and believes that they are an important part of improving the quality and safety of the care we provide. Physicians, authorized practitioners, and authorized members of our workforce are given access to these systems so that they can access your information when needed. Ebenezer has policies, processes and technical safeguards in place to protect your information from being accessed by anyone other than those authorized.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU.
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we explain what we mean and give an example. Not every use or disclosure in a category will be listed; however, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment. We may use health information about you to provide you with health treatment or services. We may disclose health information about you to physicians, nurses, technicians, medical students, or other personnel who are involved in taking care of you. For example, a physician treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the physician may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of this facility also may share health information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. We also may disclose health information about you to a specialist who is consulted about your treatment or care. It is our practice to provide information about your care and treatment received at Ebenezer to your regular physician of record so that they have appropriate information for providing future care to you.
For Payment. We may use and disclose health information about you so that the treatment and services you receive may be billed to and payment may be collected from you, the responsible party / guarantor on your account, Medicare or other governmental programs, an insurance company or a third party. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations. We may use and disclose health information about you for health care operations. These uses and disclosures are necessary to operate our facility and make sure that all of our residents receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many residents to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to physicians, nurses, technicians, medical students, and other personnel for review and learning purposes. Some times it is necessary for us to hire outside consultants to help us carry out certain health care operations. If we do so, we only provide them with health information when it is absolutely necessary and only after they have signed a written agreement agreeing to follow the terms of our Notice of Privacy Practice and applicable law.
Appointment Reminders. We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or health care.
Treatment Alternatives. We may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you.
Fundraising Activities. We may use certain limited information to contact you to raise money for Ebenezer. We may disclose demographic information to the Ebenezer Foundation, which is part of the Ebenezer System, so that the Ebenezer Foundation may ask you for a donation. We will only release contact information, such as your name, address and phone number and the dates you received treatment or services. When, and if, the Ebenezer Foundation or we contact you for a donation, you can opt out of any future fundraising contacts. If you do not want to be contacted, address your request in writing to the Ebenezer Foundation, 2722 Park Avenue, Minneapolis, MN 55407.
Resident Directory. When you are a resident at one of our facilities, we may receive calls from friends, family and others inquiring about your presence in the facility. Certain limited information about you will be considered “directory” information. This information may include your name, location, your general condition (e.g., fair, stable, etc.). You may also choose to list your faith community (religious affiliation). The directory information, except for your religious affiliation, may also be released to people who ask for you by name. This is so your family and friends can call or visit you and generally know how you are doing. If you have asked to have your faith community included in the directory, your name, general condition, and location in the facility could be given to a community faith leader (clergy), such as a priest, minister, or other spiritual advisor, even if they don't ask for you by name. Your information would only be given to community faith leaders of the faith community you provided.
Individuals Involved in Your Care or Payment for Your Care. With your permission, we may release health information about you to a friend or family member who is involved in your health care while you are a resident at one of our entities. We may also give information to someone who helps pay for your care. When asked, we may also tell your family or friends your condition and that you are at an Ebenezer facility. You may limit the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. In addition, we may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Research. By performing research, we learn new or better ways to diagnose and treat illnesses. In most cases, use of your health information for research purposes will be reviewed and approved by an Institutional Review Board (IRB). An IRB is a federally mandated board that ensures that human research subjects are protected. The IRB will either require your written approval for the use or disclosure of your health information or will waive the authorization requirement. Ebenezer will allow only internal researchers with waivers from our IRB access to your information. Before the IRB will grant a waiver, the researchers must prove that the project is important enough to justify the waiver and show they have a plan to protect the information from any improper use or disclosure.
In some cases, Ebenezer may permit access to your health information by individuals that are preparing to conduct research. Ebenezer will allow only internal researchers to access your health information and we will not permit the information to be removed from Ebenezer.
In the event that you participate in a research project that involves treatment, your right to access health information pertaining to that treatment may be denied. Your right to access the information will be reinstated upon completion of the research project.
As Required By Law. We will disclose health information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Organ and Tissue Donation. If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may release health information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.
Workers' Compensation. We may release health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose health information about you to public health authorities for certain public health activities. These include:-
- to prevent or control disease, injury or disability;
- to report deaths;
- to report reactions to medications or problems with products;
- to notify people of recalls of products they may be using;
- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe a resident has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.-
Law Enforcement. We may release health information if asked to do so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the facility; and
- In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors. We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about residents of the facility to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities. We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities
authorized by law. We may disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU.
You have the following rights regarding health information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy your health information. You must submit your request in writing to the address listed on the form you signed when you received this notice. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by us will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, submit a written request to the address listed on the form you signed when you received this notice. You must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:-
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the health information kept by or for us;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
We will notify you in writing if we deny your request. If the request is denied, you have the right to submit a written statement disagreeing with the denial, which will be appended or linked to the health information in question.
Right to an Accounting of Disclosures. You have the right to request a list of the disclosures of your health information, if any, we have made without your written authorization to third parties other than for treatment, payment, health care operations and certain other limited purposes. These disclosures are typically those required by law for purposes such as disease management, protection of vulnerable adults and death reporting. To request this list or accounting of disclosures, you must submit your request in writing to the address listed on the form you signed when you received this notice. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.-
Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. Federal law states that we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to the address listed on the form you signed when you received this notice. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the address listed on the form you signed when you received this notice. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, send your request in writing to the facility address in which you are a resident.
CHANGES TO THIS NOTICE
We are required to abide by the terms of our Notice of Privacy Practice currently in effect. We reserve the right to change this Notice of Privacy Practice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in this facility. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you come to one of our facilities for treatment or health care services, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact the Ebenezer Privacy Office, 2722 Park Avenue, Minneapolis, MN 55407. All complaints must be submitted in writing. You will not be penalized for filing a complaint. You may also submit your complaint directly to the Department of Health and Human Services – Office of Civil Rights, Hubert H. Humphrey Building, 200 Independence Avenue Southwest, Room 509F HHH Building, Washington, D.C. 20201.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you give us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
EBENEZER ENTITIES COVERED BY THIS NOTICE-
- Ebenezer Hall
- Ebenezer Luther Hall
- Ebenezer Ridges Health Care Center
- Ebenezer Arbors at Ridges
- Ebenezer Park Apartments
- Ebenezer Tower Apartments
- Ebenezer Ridge Point Apartments
- Administration of the following managed facilities
- Lake Shore Drive Condominiums
- Lee Square Cooperative
- Mighty Fortress Manor
- Osborne Apartments
- Sawtooth Ridges Apartments
- Teachers Park Avenue Residence
- Wildwood Manor
- 7500 York Apartments
- Regent at Plymouth
Legal Entities Included as Part of Ebenezer’s Covered Entity:-
- Ebenezer Foundation
- Ebenezer Society